Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, May 21, 1995 TAG: 9505200013
SECTION: HORIZON PAGE: G1 EDITION: METRO
SOURCE: SARAH HUNTLEY STAFF WRITER
DATELINE: LENGTH: Long
\ THOSE minutes before the ambulance came seemed like an hour, and they almost were one - just 22 minutes short.
Thurston "Buddy" Lawrence's first call for help came in at 9:02, the evening of March 14.
The day had been a routine one for Buddy's live-in companion, Gloria Volpe. She'd ventured out to the beauty parlor to have her hair permed. She'd joked around with her oldest son, a plumber, and his boss as they fiddled with the water pipes in her Fort Lewis home on Martin McNeil Road. She'd gone to bed early, with a romance novel in hand.
Gloria loved to lose herself in the fantasy of "those thin love stories," Buddy would say later.
But that night, reality hit. Shortly into the book, Gloria Volpe, 61, began dying.
Then, she began waiting.
\ Bruce "Rooster" Roy, president of the firefighters union, isn't afraid of controversy. Last year, he raised a ruckus when he stood in front of the Roanoke County Board of Supervisors and suggested that fire and rescue staffing was inadequate.
Armed with articles from trade publications and an analysis of the county's finances, he presented a proposal to hire more personnel.
Roanoke County's emergency squads are run by a partnership of career and volunteer crew members. On weekdays, paid firefighter/medics staff six of the county's 11 firehouses. Evenings, weekends and major holidays, volunteers take over. In some cases, volunteers supplement paid personnel during the day.
It's a blend the county says works well and keeps costs down, but the system has its problems:
While some crews have sufficient members, others struggle to recruit and train enough volunteers.
Some stations, especially those in more rural areas, sit locked up tight at night. They're full of equipment, but no people, because the county doesn't mandate across-the-board sleep-ins.
Reaction and response times remain fairly high, especially in more rural districts, and the goals differ for paid and volunteer crews.
The county cannot guarantee that advanced life support will arrive with the first response unit at night. ALS care, including the use of a defibrillator and drugs, requires additional coursework. Already saddled with time-consuming training requirements, precious few volunteers qualify.
The squads regularly fail to meet national standards for safe staffing of equipment. The National Fire Protection Association calls for an absolute minimum of four firefighters per engine. That figure is based on personnel needed to fulfill on-the-scene functions. Especially during the day, when volunteer supplements are not available, the county often sends trucks out with three firefighters.
To deal with these problems, Roy offered a big-bucks solution: Increase the 50 full-time career positions in the county's stations to 164.
"It all comes back to not having enough warm bodies. Someone needs to stand up and say we don't have enough people," he said. "One of these days someone is going to get hurt, or killed."
The union's proposal sent off shock waves. Volunteers felt threatened; and the county blanched at the thought of the expense. The issue was sent to an ad hoc committee.
Since then, the county has hired six part-time firefighter/medics and three new full-time employees, including a volunteer coordinator. Roanoke County is also sharing the costs with Vinton for three full-time employees at the town's station.
Nevertheless, a year later, the problems persist.
\ The dispatcher's first bulletin about Gloria Volpe went out that night at 9:03, calling for the closest unit to respond. The page echoed through the Fort Lewis Rescue station, bounced off the shiny trucks and ambulance, but fell on deaf ears.
The crew wasn't there.
Seven minutes later, when no county unit had started out, the dispatcher called for the next best bet - Salem.
Buddy Lawrence was worried. He'd known right away - when he saw Gloria leaning down from her bed in the next room, reaching for the trash can - that she was in bad shape.
"I'd caught her out of the corner of my eye while watching TV," he said. "She was trying to throw up. I seen a cold sweat on her so I automatically dialed 911. I knew that wasn't good."
Buddy ran next door, one house down the hill, where Gloria's brother, Gerald Martin, had just settled down for the night. When Gerald saw his sister, still sweating, vomiting and dry heaving, he "felt sure she was having a heart attack," he said.
In 1988, Gerald had a heart attack at his home. It took the Fort Lewis Rescue Squad less than 10 minutes to arrive on Martin McNeil Road then.
At 9:12 p.m., Buddy called 911 again and reported that Gloria was doing worse. The backup unit, an ambulance with the Salem Rescue Squad, hit the road at 9:17.
Buddy went outside, where he stood on the porch of Gloria's cottage-like yellow house. He paced up and down the front walk, waiting. His eyes fixated on the corner at the end of the road, willing the ambulance to round the bend. Once, he thought he heard sirens, but they faded into the distance. Outside, all was quiet.
Inside, Gloria was frightened. She'd fallen weeks before and broken bones in her hand. In the last moments before help arrived, the 61-year-old woman started beating her still-healing hand against the side of the bed and begged for the pain to end.
"You just let me die," she cried. "Just let me die."
"I kept talking to her," Gerald said later. "I stood there helpless. There wasn't anything I could do. Truth to tell, I didn't know how to help."
Thirty-eight minutes after Buddy's first call, at 9:40 p.m., the Salem ambulance pulled in front of Gloria's house. Out of their domain and unfamiliar with the twisting roads in the neighborhood above Fort Lewis Elementary School, the crew had gotten lost along the way.
They lifted Gloria into the ambulance and started down the hill. At the bottom, her heart gave out and she went into cardiac arrest. A Fort Lewis firefighter and county battalion chief met up with the Salem ambulance at the side of the road and worked on Gloria until 9:56 p.m., when they pulled into Lewis-Gale Medical Center.
A short while later, a doctor pronounced Gloria Volpe dead. The cause listed on her death certificate was ventricular tachycardia, an above-normal heart rate in one of the heart's lower chambers.
\ The county has no elaborate explanation for what went wrong on March 14.
"They didn't have anybody there that night to cover the call," Tommy Fuqua, chief of the Fire and Rescue Department, said. "I don't know why, but for whatever reason, there weren't any people."
According to Anita Hansen, who recently stepped down as chief of Fort Lewis Rescue, one of the volunteers on duty had been delayed at work and the other had broken her ankle earlier that day. When there are only 11 volunteers to spread over five nights, there isn't much hope of finding replacements, she said.
"We can't let this happen ever, ever again," said Fort Lewis Rescue's public relations officer Howard Hartman. "You can't violate the public trust like that."
The decline of the Fort Lewis Rescue Squad was a long time coming, volunteers say.
Back in March 1994, Hansen told the Board of Supervisors her squad needed help. The call volume had risen, but the number of volunteers hadn't. She asked that one career medic be assigned 24 hours a day to supplement the volunteer ranks.
Asking the county for help was no minor step. All the volunteer organizations - fire and rescue - are fiercely independent. They take pride in their achievements and resist what they see as an entrenching county authority.
"When you have to swallow your pride and ask the county for help, it's hard," Hartman said. "But we had no place else to turn."
The Fort Lewis Rescue Squad waited 11 months for assistance. In February, a paid advanced life support provider was assigned to Fort Lewis on weekends. After Gloria Volpe's death, the county extended the station's career staff hours to 12 a day, from 6 a.m. to 6 p.m., and added a second paid firefighter/medic to the weekend shift.
Roanoke County's new volunteer coordinator, Amy Shelor, has made recruiting for Fort Lewis a top priority, but the crew says finding volunteer manpower won't be easy.
"We tried everything we could, short of getting out on the street and begging people to join," Hartman said. "To have an effective and solid organization you have to have a community-based core, but we don't seem to have people who are willing to do it anymore."
Only one of the crew's volunteer members lives within the station's coverage area.
Part of the problem is the population base, Fort Lewis volunteers say. From mountaintop to mountaintop, Fort Lewis Fire and Rescue cover a radius of 17 square miles from the station. The crews serve about 3,500 residents. Forty-two percent of the squad's calls are to the Richfield retirement community, a few miles down West Main Street.
"There's very young and quite old," acting Rescue Chief Rusty Clark explained. "We don't have a 21-year-old crowd to target."
The future of the squad is uncertain.
"If the call volume stays the same or goes up and we can't get volunteers in here, then this organization will be no more," Hartman said. "I'm afraid the end is fast approaching."
When the chiefs at the county's other stations hear of Fort Lewis' problems, they acknowledge that solutions are needed. Before the conversation is over, however, they invariably point out that their squad is running calls just fine, that the crisis is with another crew.
"If the citizens were complaining that they weren't getting good service, I'd feel like we have a problem," Bent Mountain Volunteer Fire Chief Randy Wimmer said. "But I think certain people are taking the troubles of one organization - Station 9 - and spreading them out countywide."
Former Roanoke police officer Dave Simmons has looked at all the data, heard all the arguments. One of three citizens on the fire and rescue ad hoc committee, he says the problems aren't just at Fort Lewis, and fixing them will take cooperation.
"You have to look at Roanoke County as a whole. Cave Spring is just as responsible for Fort Lewis as Fort Lewis is for Cave Spring, as Hollins is for Vinton and Vinton is for Hollins," Simmons said. "You have to ask, what is your purpose? Are you here to serve your back yard or are you one of many units that serve the entire area?"
The solutions will take more than cooperation, however. Ultimately, staffing issues come down to money. And emergency service is a lot like insurance. People don't want to pay into a system of what-ifs, but when they need help, it had better be there.
The budget realities are hard to ignore, Assistant County Administrator John Chambliss said, and before supervisors will commit funds to staffing, the county's residents will have to chart out a reasonable vision for fire and rescue.
Planning is essential, John Prescott, director of West Virginia's Center for Rural Emergency Medicine, says.
"A community must wrestle with this question: What are the expectations? It's important because you sort of get what you pay for," he explained. "For a long time, EMS hasn't sat at the same table with police and fire, but it truly is the third leg of public safety."
Measuring service is complicated. Most jurisdictions use response times, the amount of time it takes for the first unit to arrive on the scene.
"It's the bottom line," citizen committee member Simmons says. "I don't care if the county sets off the alarm every 30 seconds or how they deal with the other issues. It's from the time that alarm goes off to the time they pull up in my driveway that matters most to me."
Someone who is having a heart attack has about six minutes before brain damage sets in, according to the American Heart Association, and professional fire organizations say a small fire will hit flashover and consume a house in even less time.
"That means we have to be on the scene and providing the service by then," Chambliss said. "Right now, in some cases, we're talking about it taking that long to get out of the station."
In 1994, Roanoke County crews took longer than 10 minutes to arrive on the scene in 1,553 cases, about 22 percent of the county's total calls.
Volunteers say, however, that some high response times are unavoidable.
"We respond to some places that are far away, like Cove Hollow," Fort Lewis Fire Chief Woody Henderson said. "That's a good 13 to 15 minutes. I don't care if you are career or volunteer, that's just how long it takes to get there."
And the county agrees. Fuqua argues it is misleading to include travel time.
"Response time is confused by so many different factors: traffic, weather conditions, road construction. It's hard to reduce the times when you look at all that," he said. "I guess you could build another station somewhere in between, but is that economically feasible? Not when you look at the low number of calls. We can't put a fire station on every corner."
\ So the county looks instead to reaction times, the amount of time it takes for a unit to get out of the station.
In 1994, county crews took longer than five minutes to leave the station on 773 calls, about 11 percent of the time. The numbers show a difference between reaction times during the day and at night.
"Our career people have to be out of the station in a minute and a half," Fuqua said. "That's because we're paying them to do the job and they're in-house."
There are no county-set standards for volunteers. The difference is most acute for the squads that don't require their members to sleep at the station. They carry pagers with them and respond from home. Because the volunteers have to drive to the firehouse to get equipment, the result is longer reaction times - and empty stations.
"Every day, for two solid years, I've locked this door when I leave here at 5 p.m.," Bruce Roy, a paid firefighter at Mason's Cove, said. "No one comes to take over."
Crews that include mandatory sleep-ins have seen reaction times go down, sometimes by as much as four or five minutes. Cave Spring, Clearbrook, Fort Lewis Rescue and Hollins require their members to stay in.
"You cut out a lot of time. All you have to do is get up, get dressed and go down to the trucks," said Gene File, president of Cave Spring Rescue. "You might be a bit bleary-eyed, but you can still find the trucks."
Not all the stations are equipped with sleeping facilities, however, and volunteers say there is some advantage to having members in different parts of their coverage area. They may be closer to the emergency than the station is. It works well to have a first responder who can scope out the situation and provide basic care, while others man the vehicles, they say.
"You don't see it on paper ..., but the person could have been getting help," volunteer Randy Wimmer said. "Just because a unit doesn't get out within two or three minutes doesn't mean there wasn't help living right next door."
If the county starts to set standards for reactions and responses, some say it will need to distinguish between rural and urban stations.
Supervisor Bob Johnson argued at a recent budget work session that expectations should differ for more remote areas, like Bent Mountain and Back Creek.
"This may be controversial, but if you've chosen to live out there, you shouldn't expect us to get anything out to you in four minutes," said Johnson, who lives in the more populated Hollins Magisterial District. "On the other hand, if you aren't at my house within four minutes you have a serious problem. I can guarantee you that."
The county will have to work out issues beyond how long it takes someone to arrive. The other part of the equation is how prepared the people are who show up.
Currently, the county can guarantee advanced life support care during the day, but not at night. If the volunteer crew does not include an on-duty paramedic, the emergency medical technicians can only administer basic care.
A crew can radio for backup assistance and wait for an ALS-staffed unit to arrive, Fuqua said. But that takes more time, and it's often faster to head for the hospital.
County Administrator Elmer Hodge says continual ALS care may not be cost-effective.
"The expectations of citizens have increased manifold. No longer are we expected to appear and transport. We are expected to provide the highest level of service on the scene immediately," Hodge said. "People expect a level of service almost like the care found in emergency rooms and operating rooms, but the resistance to paying for it is still there."
Gloria Volpe's family realizes the problems are complex. They have been longtime supporters of volunteer squads. Gloria donated money to Fort Lewis every year.
"You've got to admire the crews for what they do - paid or volunteer, and it's hard to criticize someone who is volunteering to work," Gerald Martin said. "But I think the county should have some paid ones at night."
He doesn't know if his opinion will matter. "One person doesn't make a whole lot of noise," he said.
But Gerald and other relatives hold fast to the belief that Gloria may have survived if someone had been at Fort Lewis that night, and John Fant, Gloria's oldest son, plans to ask the attorney general to investigate the incident.
"Gloria was one in a million. I just wish they would have responded," John's wife, Vickie, said. "If someone had been at Fort Lewis, I think that lady would still be alive today."
by CNB